Saturday, April 22, 2017

My 97-year-old patient revealed this to me during our first meeting in my clinic examination room. He had just moved to an assisted living facility in Cleveland to be near his son and daughter-in-law, who also sat in the room. They were quiet as they watched us interact.

"What do you mean?" I asked.

He rested both forearms on the high arms of his wheelchair, which caused his shoulders to hunch and gave the impression that he was about to spring into action. He spoke deliberately, choosing his words carefully. His eyes were rheumy but sharply focused, commanding my attention. I got the impression he was used to being in charge.

"I don't want to end up… you know, blotto," he said, quickly pantomiming a person slouched to one side of his chair, mouth open. His son and daughter-in-law glanced at each other and then at me as they arched their eyebrows in surprise.

"Why do you think that might happen?" I asked.

"Because of my medical condition, or whatever you're going to recommend I treat it with," he answered, matter-of-factly.

He had abnormal blood counts, but no established diagnosis. He was anemic, requiring a blood transfusion every two months, just often enough to be a nuisance for anybody. His platelets were low, but not low enough to put him at risk for bleeding or to require platelet transfusions. And his white blood cell count was decreased, though again, not enough to render him prone to infections.

Friday, April 21, 2017

Well-timed pulses from electrodes implanted in the brain can enhance memory in some people, scientists reported on Thursday, in the most rigorous demonstration to date of how a pacemaker-like approach might help reduce symptoms of dementia, head injuries and other conditions.

The report is the result of decades of work decoding brain signals, helped along in recent years by large Department of Defense grants intended to develop novel treatments for people with traumatic brain injuries, a signature wound of the Iraq and Afghanistan wars. The research, led by a team at the University of Pennsylvania, is published in the journal Current Biology.

Previous attempts to stimulate human memory with implanted electrodes had produced mixed results: Some experiments seemed to sharpen memory, but others muddled it. The new paper resolves this confusion by demonstrating that the timing of the stimulation is crucial.

Zapping memory areas when they are functioning poorly improves the brain's encoding of new information. But doing so when those areas are operating well — as they do for stretches of the day in most everyone, including those with deficits — impairs the process.

"We all have good days and bad days, times when we're foggy, or when we're sharp," said Michael Kahana, who with Youssef Ezzyat led the research team. "We found that jostling the system when it's in a low-functioning state can jump it to a high-functioning one."

Researchers cautioned that implantation is a delicate procedure and that the reported improvements may not apply broadly. The study was of epilepsy patients; scientists still have much work to do to determine whether this approach has the same potential in people with other conditions, and if so how best to apply it. But in establishing the importance of timing, the field seems to have turned a corner, experts said.

SYDNEY, Australia — How can I tell you what I have done? Let me start with a doorway. I am looking in at a patient handcuffed to the rails of a hospital bed, arms spread out in a crucifixion pose. The prison guards who have brought the patient to the hospital explain what has happened. I hide my horror behind my calm and neutral doctor face as I unfurl crepe bandages from self-inflicted wounds. Just another set of wounds to add to all the others in my head, the weeping pressure sores of nursing home residents, the gangrenous toes that you can smell from the other side of the room.

The job of a doctor in training is unspeakable. It is hard to find the words to describe what we do. It is hard to work out whom to tell. We cannot speak of these things to people outside medicine because it is too traumatic, too graphic, too much. But we cannot speak of these things within medicine, either, because it is not enough, it is just the job we do, hardly worth commenting on.

When I started working as a doctor last year in a metropolitan public hospital in Sydney, rotating through the emergency department and the surgical and medical wards, as all doctors do in their first year of practice in Australia, my experiences were no better or worse than those of any of my colleagues. Nor are they dissimilar to the experiences of junior doctors around the world. But we are speaking about these things now, where I am from, because my colleagues are killing themselves.

It has long been recognized that physicians are more likely than the general population to kill themselves, especially if they are female. A meta-analysis of studies around the world on doctor suicide found that female doctors were more than twice as likely as the general population to die this way.

Younger doctors are particularly vulnerable. In the United States an estimated average of 28 percent of medical residents show signs of depression during training, making them around three times more likely to be depressed than similarly aged Americans. A 2013 survey of Australian doctors by the mental health nonprofit organization Beyond Blue found that young doctors worked longer hours than their older colleagues, in some cases up to 50 hours or more per week on average. Younger doctors were also more psychologically distressed and more burned out, and thought about suicide more often. Here in Sydney we have lost three colleagues in the last seven months alone.

Wednesday, April 19, 2017

It looks like just another beige office park building next to a dental office in Menlo Park, California. Yet Building 8, across the street from Facebook's main campus, houses the social network's biggest bets on out-there products.

The tech industry has a term for what people inside Building 8 work on: moonshots. Think potentially groundbreaking projects that could reshape Facebook's long-term future and even how all of us communicate.

CEO Mark Zuckerberg unveiled Building 8 (named for the number of letters in Facebook) at last year's F8 developer conference. He also revealed he'd recruited Regina Dugan from Google's Advanced Technology and Projects (ATAP) group to head Facebook's skunkworks efforts, as part of Zuckerberg's 10-year strategic plan.

Since then, Facebook has given tantalizing hints about Building 8's mission, saying only that it's focused on "seemingly impossible" hardware in augmented and virtual reality, artificial intelligence, connectivity and "other important breakthrough areas," with "clear objectives for shipping products at scale." The one thing we knew for sure: The company had been amassing a dream team of hardware veterans from the likes of Apple, Motorola, Google and other industry heavyweights.

Some of that secrecy faded Wednesday, when the group unveiled its first two projects: a "brain-to-computer interface" that would allow us to send thoughts straight to a computer, and technology to "hear" or absorb language through vibrations on our skin.

"If I'm doing my job well, we should deliver things people didn't know to ask for," Dugan -- who previously headed Darpa, the Defense Department's famed tech arm -- tells me Monday from a working space on Facebook's campus. "There's the risk of failure. But that's precisely the price you pay for the honor of working on something new."

We used to think the world was flat, until teams of pioneers discovered new lands and pushed the boundaries of knowledge. We're at a similar turning point with health and disease: we now have the advanced tools and technologies to explore health in greater depth and detail than previously imaginable.

Project Baseline is the quest to collect comprehensive health data and use it as a map and compass, pointing the way to disease prevention.

Google knows all about your habits and interests online. Now the search company's health spinout, Verily, is asking 10,000 Americans for intimate knowledge of their bodies.

Verily today published a website that marks the launch of its founding idea, the Baseline Project, a multi-year study expected to cost more than $100 million that it says will search for clues to predicting heart disease and cancer.

Volunteers are being asked to submit to an unprecedented regimen of tests and physical monitoring. They'll be asked to wear a heart-tracking watch that follows their pulse and movements in real time and will undergo a detailed workup of x-rays and heart scans, in addition to having their genomes deciphered and their blood tested in so-called liquid biopsies, which might be able to catch cancer early.

Each volunteer will be monitored for four years. As enrolling 10,000 people will take time, the full study could take a decade to complete.

"No one has done this kind of deep dive on so many individuals. This depth has never been attempted," says Sanjiv Sam Gambhir, a physician researcher at Stanford University who is one of Baseline's investigators. "It's to enable generations to come to mine it, to ask questions, without presupposing what the questions are."

Ada, a London and Berlin-based health tech startup, sees its official U.K. push today, and in doing so joins a number of other European startups attempting to market something akin to an AI-powered 'doctor'.

The company's mobile offering bills itself as a "personal health companion and telemedicine app" and via a conversational interface is designed to help you work out what symptoms you have and offer you information on what might be the cause. If needed, it then offers you a follow up remote consultation with a real doctor over text.

In a call, two of Ada's founders — CEO Daniel Nathrath and Chief Medical Officer Dr Claire Novorol — explained that the app has been six years in the making, and actually started life out as being doctor-facing, helping clinicians to make better decisions. The same database and smart backend is now being offered to consumers to access, albeit with a much more consumer-friendly front-end.